Healthcare Provider Details

I. General information

NPI: 1306536354
Provider Name (Legal Business Name): ALLEGIANCE BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 TODDS LN STE 240
HAMPTON VA
23666-3197
US

IV. Provider business mailing address

1702 TODDS LN STE 240
HAMPTON VA
23666-3197
US

V. Phone/Fax

Practice location:
  • Phone: 757-251-2548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE SKINNER
Title or Position: CEO
Credential:
Phone: 757-303-4430